Welcome to the BREEZE TRANSPLANTTM online health history questionnaire.

Please answer all questions truthfully, accurately, and
completely, as the information provided here will be used by our Living
Donor Team to detect any medical conditions that may affect your ability
to be a living donor.

This questionnaire is confidential. Only health professionals
on the Living Donor Team will use this information. This information
will not be shared with the transplant candidate or others.

Please choose below whether you wish to be evaluated for living kidney or liver donation.